1.0 DESCRIPTION
The TAMP establishes TRICARE eligibility
for specific categories of beneficiaries. The sponsors and their
family members are eligible for continued TRICARE medical benefits
including enrollment/re-enrollment in TRICARE Prime or TRICARE Select,
services and supplies provided under the Extended Care Health Option
(ECHO), and Military Treatment Facility (MTF)/Enhanced Multi-Service
Market (eMSM) care, for a defined period of time as indicated on
Defense Enrollment Eligibility Reporting System (DEERS). While the
status of these individuals is neither active duty nor retiree/deceased,
for the purpose of cost-sharing, the claims for these individuals
(including the former active duty member) shall be processed as
Active Duty Family Members (ADFMs).
Note: In this section,
references to TRICARE Select coverage are effective for services
received on or after January 1, 2018.
2.0 POLICY
2.1 Covered
Groups (Section 1145 of Title 10, United States Code (10 USC 1145)).
Members, as determined by their Service personnel office and indicated
in DEERS, and their eligible family members who meet the criteria
below are entitled to medical benefits under TRICARE to the same
extent as those available to ADFMs.
2.1.1 A member who is involuntarily separated
from active duty as defined in 10 USC 1141.
2.1.1.1 This
includes a member who is provided a voluntary separation incentive
under 10 USC 1175(j).
2.1.1.2 This includes
a member who is separated from active duty and receives voluntary separation
pay, and not entitled to retired or retainer pay upon separation,
under 10 USC 1175a(e)(2)(A).
2.1.2 A member of a Reserve Component (RC) who
is separated from active duty after serving more than 30 consecutive
day either in support of a contingency operation or for a preplanned mission.
Preplanned mission was added by Public Law 115-91, effective December
12, 2017.
2.1.3 A
member who is separated from active duty for which the member is
involuntarily retained under 10 USC 12305 (also referred to as “stop
loss”) in support of a contingency operation.
2.1.4 A member who
is separated from active duty pursuant to a voluntary agreement
of the member to remain on active duty for a period of less than
one year in support of a contingency operation under 10 USC 1145(a)(2)(D).
2.1.5 A member who
receives a sole survivorship discharge as defined in 10 USC 1174(i).
This provision was added by Public Law 110-317, effective August
29, 2008.
2.1.6 A
member who is separated from active duty who agrees to become a
member of the Selected Reserve of the Ready Reserve of an RC. This
provision was added by Public Law 110-417, effective October 14,
2008.
2.1.7 A
member who completes orders of more than thirty continuous days
of qualifying full-time National Guard Duty in support of the Government
coronavirus (COVID-19) response. This provision was added by Public
Law 116-283, Section 733, effective January 1, 2021.
2.2 Time
frames of eligibility for TAMP eligibles in which the member’s separation
occurred on or after November 6, 2003 - Transitional health care
for TAMP eligibles shall be available for 180 days beginning on
the date on which the member is separated from active duty.
2.3 Determining
Eligibility
2.3.1 Eligibility
determinations for coverage must be based on DEERS determinations.
2.3.2 Contractors
shall be responsible for confirming DEERS eligibility status. Once
jurisdictional responsibility is established, the contractor shall
have the capability by using DEERS to identify these claims as TAMP
and process them as ADFM claims. While the status of these individuals
is neither active duty nor retiree/deceased, for the purpose of
cost-sharing, the claims for these individuals shall be processed
as ADFMs. Eligibility verification of an active duty member who
was separated involuntarily shall be based solely on the DEERS response.
For those claims that are submitted for medical services rendered
to the sponsor and if the contractor can identify the claim as meeting
the transitional eligibility requirements, the contractor shall
process the claim. Otherwise the sponsor claims indicating status
as “active duty” and relationship as “self” shall continue to be
transferred to the military services. Claims shall be processed
by the contractor using the same rules and cost-shares that apply
to ADFMs per TRICARE Reimbursement Manual (TRM),
Chapter 2,
unless otherwise specified in
Chapter 10, Section 8.1.
2.4 Change in eligibility
status of a beneficiary during an inpatient hospital stay (see the
TRM,
Chapter 6, Section 2).
2.5 In cases involving
the existence of Other Health Insurance (OHI) for family members
and/or sponsors, treat as double coverage as required by the TRM.
2.6 TRICARE Prime
(Before January 1, 2018)
2.6.1 Enrollment in Prime. TAMP eligibles may
enroll or re-enroll in TRICARE Prime.
2.6.2 Effective Date of Enrollment in
TRICARE Prime is as follows:
2.6.2.1 TAMP
eligibles (including the former active duty member) who were enrolled
in Prime immediately prior to their change in status may continue
their enrollment in TRICARE Prime with no break in coverage. A reenrollment
application must be completed prior to the TAMP expiration period in
order to continue with TRICARE Prime. The effective date shall be
the date the sponsor separated from active duty as the intent is
to ensure that Prime coverage is seamless. See
Section 2.1 for
further information on the effective date of enrollment.
2.6.2.2 TAMP eligibles
who were not enrolled in Prime (including TRICARE Prime Remote (TPR)
and TRICARE Prime Remote Active Duty Family Member (TPRADFM)) immediately
prior to their change in status may choose to enroll in TRICARE
Prime while receiving TAMP coverage. See
Section 2.1 for further
information on the effective date of enrollment.
2.6.2.3 TAMP eligibles
whose sponsor is called to active duty.
2.6.2.3.1 TAMP eligible
family members who were enrolled in Prime immediately prior to their sponsor’s
change in status to active duty may continue their reenrollment
in TRICARE Prime with no break in coverage if they reenroll in TRICARE
Prime within 90 days of the return to active duty status. If reenrollment
is accomplished within 90 days of the return to active duty status,
the reenrollment will be retroactive to the date of the change in
status from TAMP to active duty. If reenrollment is not accomplished
within 90 days of the return to active duty status, the enrollment
will be effective the date the request is received or postmarked.
2.6.2.3.2 TAMP eligible
family members not enrolled in Prime immediately prior to activation (i.e.,
return to active duty) may choose to enroll in Prime. See
Section 2.1 for further information on effective
date of initial enrollments and reenrollments.
2.6.2.3.3 For information
on the effective dates of enrollments for Service members, see the TRICARE
Operations Manual (TOM),
Chapter 6, Section 1.
2.6.2.4 While
the TPR and TPRADFM are not available to TAMP eligibles, these programs
are considered a “Prime-like” benefit and enrollment or reenrollment
in Prime shall be available to them as stated above.
2.7 TRICARE Prime And TRICARE Select (Effective
January 1, 2018)
2.7.1 Enrollment
A change in
status listed in
paragraph 2.1 is a Qualifying Life Event (QLE).
As such, TAMP-eligible members and family members may be auto-enrolled
in TRICARE Select. If not auto-enrolled in TRICARE Select, TAMP
eligibles, including the former Service members may elect to enroll
or re-enroll in TRICARE Prime, if qualified or TRICARE Select coverage
within 90 days of their eligibility for TAMP.
2.7.3 TAMP eligibles whose sponsor is
called to active duty.
2.7.3.1 A TAMP sponsor’s
re-activation to active duty status is a change in status, and is
a QLE that allows TAMP enrollees to elect their desired TRICARE
coverage within 90 days of the activation.
2.7.3.2 While the TPR and TPRADFM are not
available to TAMP eligibles, these programs are considered a “Prime-like”
benefit and enrollment or reenrollment in Prime shall be available
to them as stated above.
2.8 TRICARE
Reserve Select (TRS) may be available for purchase by members of
the Selected Reserve as specified in the TOM,
Chapter 22, Section 1. In order to continue
TRICARE coverage with no break, an application for TRS may be produced
up to 90 days before the expiration date of TAMP, but must be submitted
with the required initial payment no later than 90 days after the
expiration date of TAMP.
2.9 The
Continued Health Care Benefit Program (CHCBP) may be available to
members (and their dependents) after the expiration of TAMP entitlement.
See
Section 4.1 for further information.
2.10 Dental Coverage
2.10.1 Dental
benefits for TAMP-eligibles are limited to space available care
in the Dental Treatment Facility (DTF).
2.10.2 Effective January 27, 2012, dental
benefits for RC members discharged from active duty after more than
30 days in support of a contingency operation are available in the
same manner as a member of the uniformed services on active duty
for more than 30 days. This requires care to be provided in both
military DTFs and authorized private sector dental care. This care
will run concurrently with the member’s TAMP coverage.
2.10.3 The
TRICARE Dental Program (TDP) is a voluntary dental insurance program
that is available to ADFMs, Selected Reserve, and Individual Ready
Reserve (IRR) members, and their eligible family members. The TDP
is not part of the benefits offered under TAMP. Sponsors who were
enrolled in the TDP prior to being activated, who then return to
Reserve status, may be eligible to re-enroll in the TDP.